Динамический мониторинг сердечно-сосудистых заболеваний у пациентов с сахарным диабетом по данным обследования в мобильном медицинском центре (Диамодуль) в регионах России

Abstract

Background. Diabetes mellitus (DM) is a powerful factor in the development and progression of cardiovascular diseases (CVD), it produces poor prognosis, in-cluding disability and premature mortality in this category of patients. Aim. To carry out dynamic monitoring of the prevalence of CVD in adult DM patients with type 1 and type 2 (coronary heart disease, myocardial infarction, ce-rebrovascular diseases and arterial hypertension) based on a comprehensive examination in a mobile medical center (Diamodule) with repeated visits to the re-gions in 2019 compared to data of the Federal Program "Diabetes mellitus" (2005–2006). Materials and methods. The object of the study: adult patients with DM1 and DM2 (≥18 years old) who underwent examination in Diamodule (n=1480): 882 patients were in 2005/2006 (337 with DM1 and 545 with DM2) and 598 were in 2019 (275 with DM1 and 323 with DM2). Examination at the medical center in-cludes: assessment of anthropometric data (height, weight, body mass index), biochemical data of blood lipids and creatinine levels with calculation of glomerular filtration rate, measurement of glycated hemoglobin (HbA1c), blood pressure, ECG, cardiologist’s consultation with an assessment of the anamnesis data, la-boratory data, ECG. Results. Over the past 13–14 year period in both types of DM, the prevalence of coronary heart disease significantly decreased: in DM1 by 4,42% by 2 times (p=0,037), in DM2 by 18,34% by 2,7 times (p<0,001); myocardial infarction in DM1 by 1,97% by 1,9 times (p=0,172), in DM2 by 3,28% by 1,5 times (p=0,1); cerebrovascular diseases in DM1 by 2,17% by 3 times (p=0,074), in DM2 by 1,45% by 1,2 times (p=0,44). There was an improvement in the diagnosis of arterial hypertension compared to 2005/2006: in DM1 by 6,4% from 44,5 to 51% (p=0,115), in DM2 by 3,6% from 86,8 to 90,4% (p=0,096). It was revealed that the incidence of CVD with active screening in Diamodule is higher than the recorded data on referral compared with the data of the DM register. DM1 patients in the 2019 were significantly older (39 vs 38 years), with a shorter DM duration (18 vs 25 years), with a better HbA1c level (8,7 vs 9,1%). DM2 patients in the 2019 were significantly older (66 vs 58 years), differed in age of diabetes onset (52 vs 51 years), longer duration of DM2 (14 vs 7 years), lower glomerular filtration rate (54 vs 90,6 ml/min/1,73 m2), they had better level of total cholesterol (4,6 vs 5,1 mmol/L), triglycerides (1,3 vs 2,1 mmol/L), while they did not differ in the level of HbA1c and body mass index. Conclusions. The analysis showed a significant decrease in the prevalence of CVD in DM patients compared with the data obtained in the period 2005–2006, this is the result of CVD prevention programs and improving the quality of medical care for this category of patients.